- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.93 / $145.06 / $251.64
| Professional | | $123.93 | $145.06 | $251.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.31 / $125.63 / $130.77
| Professional | | $118.31 | $125.63 | $130.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.12 / $113.49 / $131.93
| Professional | | $85.12 | $113.49 | $131.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.26 / $130.47 / $228.83
| Professional | | $107.26 | $130.47 | $228.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.04 / $128.18 / $1,624.00
| Professional | | $104.04 | $128.18 | $1,624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.04 / $128.18 / $169.65
| Professional | | $104.04 | $128.18 | $169.65 |